The goal of cholesterol-lowering therapy in hypercholesterolemic patients at high risk for recurrence of coronary heart disease (CHD) is the prevention of acute coronary syndrome by stabilization of coronary atheromatous plaque. We often encounter patients in whom it is difficult to maintain the serum cholesterol level at a desirable level ...

The use of statin agents in patients with acute coronary syndromes (ACSs) remains an area of intense clinical interest. Statin therapy has an established secondary preventive benefit in patients with coronary artery disease, and its extension to ACS seems logical. A number of observational studies have shown an association between ...

There is clear evidence of lipoprotein oxidation in atherosclerotic lesions. Animal studies and observational prospective human cohort studies have been interpreted as supporting a role for antioxidants in the prevention of coronary heart disease (CHD). However, firm recommendations to take antioxidant supplements to treat or prevent CHD require evidence derived ...

An important issue for stroke prevention is identification and treatment of risk factors such as hypercholesterolemia. The four reasons to test hypolipidemic agents in stroke prevention are: (i) a statistical link between elevated low-density lipoprotein cholesterol (LDL-c) or decreased high-density lipoprotein cholesterol (HDL-c) and ischemic stroke; (ii) a reduction in ...

3-Hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are greatly contributed to the treatment of hypercholesterolemia, and constitute an important part of comprehensive strategies for the treatment of cardiovascular disease in the 21st century. Particularly, a strategy for preventing acute coronary syndrome (ACS), the most important complication of hyperlipidemia, is urgently ...

Event trials using statin therapy have shown a beneficial effect on rates of cardiovascular events. The three statins that have been used in long-term trials have shown generally similar effects on rates of myocardial infarction, stroke, revascularizations, and mortality. Safety data appear to be comparable for lovastatin, pravastatin, and simvastatin. ...

HMG Co-A reductase inhibitors(statins) have been shown, in three large randomized trials, to decrease adverse cardiac events in patients with clinically evident coronary artery disease. All of these trials have excluded patients with an acute coronary syndrome within the three months prior to enrollment. Statin therapy is thought to stabilize ...

BACKGROUND: Definite evidence has been established, that coronary patients benefit from appropriate secondary prevention measures, as recommended by the European and National Guidelines. EuroAspire I (1995) and EuroAspire II (1999) were surveys aimed to evaluate the state of the implementation of guidelines into the every-day medical practice in several European ...

BACKGROUND: Hypercholesterolemia induces functional and structural changes of the microvasculature and reduces coronary flow reserve in humans and experimental animals. The effect of hypercholesterolemia on left ventricular (LV) function in the absence of coronary stenosis is, however, unknown. Our objective was therefore to assess the effect of hypercholesterolemia and cholesterol ...

BACKGROUND: Although hypercholesterolemia is a well-defined risk factor for morbidity and mortality in coronary artery disease, the relationship between cholesterol and heart failure (HF) has rarely been investigated. METHODS: Cholesterol and lipoproteins were measured in 1,134 patients with advanced HF who presented to a single center for HF management and ...

PURPOSE OF REVIEW: Despite changes in lifestyle and the use of effective pharmacologic interventions to lower cholesterol levels, coronary heart disease remains the major cause of morbidity and mortality in the developed world. Cholesterol screening fails to identify almost 50% of those individuals who will present with acute coronary syndromes. ...

AIM: To determine whether statin therapy initiated early in acute myocardial infarction together with thrombolytic therapy in patients with acute myocardial infarction results in clinical benefit through early plaque stabilization. METHODS AND RESULTS: The study population consisted of 77 patients who underwent coronary balloon angioplasty of the infarct-related artery during ...

Gender-based differences in the incidence of hypertensive and coronary artery disease, the development of atherosclerosis, and myocardial remodeling after infarction are attributable to the indirect effect of estrogen on risk factor profiles, such as cholesterol levels, glucose metabolism, and insulin levels. More recent evidence, however, suggests that activated estrogen receptor ...

This review examines the use of HMG-CoA reductase inhibitor (statin) medications early in the clinical course of acute coronary syndrome. Available data demonstrate that there are clear clinical benefits to this practice. Numerous previous studies have documented the primary and secondary benefits of statins in the prevention of coronary events. ...

The peripheral vascular system makes up the largest single "organ system" and holds many biological secrets that, when unlocked, can open doors for new treatments for all vascular beds, including those of the coronary and cerebral arteries. The coronary and noncoronary circulations are inseparable and interdependent. Cardiologists as well as ...

Despite the significant advances made in the treatment of acute coronary syndromes (ACS) with antiplatelet and antithrombotic therapy, the risk of serious complications remains high, especially in the first few months following an acute coronary event. Although lipid-lowering therapy in patients with significant risk factors (primary prevention) or stable coronary ...

Peripheral arterial disease (PAD) is associated with a high morbidity and mortality, largely from coronary and cerebrovascular disease, which often overshadows the PAD itself. Best Medical Therapy (BMT), comprising smoking cessation, antiplatelet agent use, cholesterol reduction, exercise therapy, and the diagnosis and treatment of hypertension and diabetes mellitus; is evidenced ...

To determine the prevalence and correlates of lipid lowering drug use among older British men with established coronary heart disease (CHD). Cross sectional survey within a cohort study (British regional heart study) carried out at 20 years of follow up in 1998-2000. General practices in 24 British towns. 3689 men ...

The current and future roles of statins as antilipemic agents for the prevention and management of coronary artery disease (CAD) are reviewed. Therapy with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) substantially reduces total cholesterol and low-density-lipoprotein (LDL) cholesterol concentrations. Large clinical trials have documented the efficacy of statin therapy for both ...

BACKGROUND: Studies on the impact of elevated levels of lipoprotein(a) (Lp[a]) or apolipoprotein(a) (apo[a]) on the development of coronary artery disease have given controversial results. The relationship between apo(a) phenotypes and coronary artery stenosis remains unclear. METHODS: Lipid profiles, and apo(a) levels and phenotypes were analyzed in 225 patients who ...

AIM: To determine distribution, size, and phenotype of low density lipoprotein (LDL) subclasses and examine the influence of plasma lipid concentrations on lipoprotein particle size in both healthy population and patients with myocardial infarction. METHOD: Nondenaturing gradient (3-31%) gel electrophoresis for lipoprotein separation was used to determine the distribution and ...

The response to injury in the vasculature and the heart is inflammation. Atherosclerosis is often the result of injury followed by inflammation and atherosclerosis. Vascular and myocardial infections from various pathogens, including viruses, bacteria, chlamydia, and other infections result in vascular inflammation and almost certainly play a role in the ...

Cardiologists have traditionally focused on coronary narrowing as seen on angiography and have orientated treatment towards bypassing these lesions or widening them with angioplasty. In patients with stable coronary artery disease, percutaneous coronary interventions reliably relieve angina and myocardial ischemia, but do not prevent myocardial infarction or reduce mortality. Cholesterol ...

BACKGROUND: C-reactive protein is a valid marker of cardiovascular risk. It is not known whether C-reactive protein is a marker of atherosclerotic burden or whether it reflects a process (e.g. inflammatory fibrous cap degradation) leading to acute coronary events. This study was performed to determine whetherthe concentration of C-reactive protein ...

BACKGROUND: Familial combined hyperlipidemia (FCHL) is the most common hereditary lipid disorder that predisposes the patients to premature coronary heart disease. Members of FCHL families are categorised as affected or unaffected according to serum lipid levels. This study is aimed to evaluate whether there is a difference in carotid artery ...

In the last decade, an increasingly sophisticated understanding of the pathogenesis of atherosclerosis and its cardiovascular consequences has emerged. The characteristics of the unstable atherosclerotic plaque, the substrate for the majority of acute coronary events, have been well defined: mild-to-moderate stenosis, a lipid-rich pool, few smooth muscle cells, a friable ...

The development of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) has been a very significant development in the management of coronary artery disease. Large prospective clinical trials have provided unequivocal evidence that cholesterol lowering therapy with statins reduces all-cause mortality in patients with coronary artery disease. There is now ...

The author and four independent experts evaluated the intent and quality of scientific evidence for a potential beneficial health relationship between the intake of walnuts and the reduction and prevention of coronary heart disease. The report also addresses the supporting evidence for the health benefit of other tree nuts and ...

To quantify changes in 30 day and one year mortality among patients with acute myocardial infarction in southern Derbyshire (population 560 000) in each of five consecutive years (1995-1999) before the publication of the National Service Framework for coronary heart disease, and to assess the proportion of one year survivors ...

The concept of plaque stabilization was developed to explain how lipid lowering could decrease adverse coronary events without a substantial reduction in the regression of atherosclerosis. Plaques were stabilized by reducing serum cholesterol leading to several favorable pathobiological changes in the vessel wall of lipid-rich plaques responsible for a majority ...

BACKGROUND: The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study showed that pravastatin therapy over 6 years reduced mortality and cardiovascular events in patients with previous acute coronary syndromes and average cholesterol concentrations. We assessed the longer-term effects of initial treatment with pravastatin on further cardiovascular events and mortality ...

Few things are better understood within the medical community than the relationship between elevated total and low-density lipoprotein cholesterol (LDL-C) levels, cardiovascular disease and death. There is consensus in the treatment guidelines of numerous national and international bodies that cholesterol levels in at-risk patients should be reduced to target levels ...

Atherosclerosis is not an inexorable part of aging. Addressing unhealthy lifestyle behaviors will go a long way toward reducing the current burden of atherosclerosis without widespread drug therapy. The question is whether this is possible, given the demand of our modern culture. It is not yet clearly established precisely where ...

BACKGROUND: It has been suggested that infection with Chlamydia pneumoniae(CPn) can trigger inflammatory mechanisms that may in turn impair vascular endothelial function. The aim of the present study was to assess whether treatment with the macrolide antibiotic azithromycin improves endothelial function in patients with coronary artery disease and antibodies positive ...

Three large secondary prevention studies have shown that, in patients with a history of cardiovascular disease, statin treatment reduces the risk of further events and lowers overall mortality. In these studies, total mortality was reduced by as much as 30% in high-risk groups and 22% in average-risk groups. However, these ...

OBJECTIVE: To evaluate the implementation of secondary prevention and treatment of coronary heart disease (CHD) in general practice in Iceland. SETTINGS: Two health care centers adjacent to Reykjavik with a total of 25766 inhabitants. PATIENTS: All patients (533) with CHD living in the study area were sent an invitation letter ...

Community studies have demonstrated suboptimal achievement of lipid targets in the management of patients with coronary heart disease (CHD). An effective strategy is required for the application of evidence-based prevention therapy for CHD. The objective of this study was to test coaching as a technique to assist patients in achieving ...

After acute myocardial infarction, patients remain at high risk for recurrent cardiovascular events and mortality. Despite the compelling scientific and clinical trial evidence that lipid-lowering medications reduce mortality in patients after acute myocardial infarction, this life-saving therapy continues to be underutilized. A number of studies in a variety of clinical ...

Murine models of atherosclerosis, such as the apolipoprotein E (apoE) or the LDL receptor knockout mice, usually do not exhibit many of the cardinal features of human coronary heart disease (CHD), eg, spontaneous myocardial infarction, severe cardiac dysfunction, and premature death. Here we show that mice with homozygous null mutations ...

To assess use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction. Telephone survey and administrative data. National managed-care company. Six hundred ninety-six adults age 30 to 64 surveyed in 1999, approximately 1 to 2 years after a myocardial infarction. Use of cholesterol-lowering drugs, beliefs about the ...

BACKGROUND: Inappropriate inflammation is a key mechanism in the development of atherosclerosis. Antibodies against components of the atherosclerotic lesion, in particular, oxidised low density lipoprotein, have been described. OBJECTIVE: To determine whether a systemic autoimmune response, characterised by the presence of high titres of antinuclear antibodies, is associated with the ...